Review - An American ObsessionScience, Medicine, and the Place of Homosexuality in Modern Societyby Jennifer TerryUniversity of Chicago Press, 1999Review by Sundeep Nayak, M.D.Jan 18th 2001 (Volume 5, Issue 3)

Homosexuality was first used in the late 1800s to refer to an erotic desire for persons of the same sex. Later, the term heterosexuality was developed. Homosexuality was integral to the development of the Terman and Miles Masculine-Feminine test: focusing on deviant characters became a means for constituting norms in relation to which the larger population would be measured.

Scientific and, by efflorescence, popular concepts of fluid sexuality have changed much in the latter half of the last century. While a lot has been only recently learned about the development of sexual orientation, significantly more remains enigmatic. Whereas attitudes toward gay and lesbian individuals have improved considerably, the anti-homosexual bias continues to be widespread and to harm those targeted, physically and otherwise. As Terry's pages fly across the eye, we learn that initial scientific research focused largely on finding a singular vector for the pathology while typically ignoring cultural and psychological factors. Since the removal of homosexuality from the list of mental disorders in 1973, more complex issues have arisen about its conceptualization. Although the limelight showers upon while blinding white, urban, middle-class men, the need to dissect variations of sexual orientation in other groups, such as women and non-Caucasians, is now broadly recognized.

Before its post as a contagious and remediable mental illness, homosexual practices were important in ancient Greek and other cultures. Homosexual acts had been both ritualized and prohibited in various societies, but the idea of identifying a person based exclusively on regular participation in homosexual behavior is a byproduct of the medicalization of homosexuality during the nineteenth century. Homosexuals were then seen as contrary to nature according to the two crosscutting axes of sexuality and gender, and hence were known as 'inverts'. Debates ensued over whether this creature was fundamentally dangerous, merely pathetic, or a brilliantly evolved hallmark of advanced civilization. It was thought that the pressures of modern life undermined moral constraints, activated pathological tendencies, and led to bad breeding, thus allowing tainted individuals to produce innately perverse offspring. The homosexual's implicit refusal to procreate represented a pathological response to the demands of modern civilization: cultural complexity taken to the point of elective sterility. Did the homosexual then do a greater service to society by not reproducing or did he need to be recuperated and reformed by the majority community? The evolution of scientific thought (and bias) towards homosexual expression is an endless buffet of fodder from which Terry culls into her bottomless bowl, which rather delightfully includes the pernicious homoeroticism featured in comics such as Batman and Wonder Woman.

In 1864, Ulrichs, a man not formally trained in science but an early advocate of homosexual rights, was the first to come up with a scientific theory of homosexuality as an inborn benign anomaly. Freud believed that homosexuality was an arrest in development from an instinctual bisexuality to a mature heterosexuality, the natural outcome of normal development. Ellis explained it as the result of a congenital organic variation: just as the color-blind was unable to distinguish between certain colors, the homosexual was unable to see and feel normal emotional desires toward the opposite gender. Early biological theories of its origin emphasized heredity, humoral influences, and anatomical differences that served to justify subsequent eugenic German efforts to eradicate homosexual persons. The almost exclusive emphasis on the early studies of gay men parallels later twentieth-century biological research that has largely ignored homosexuality in women. In Terry's broad spectral profile, these paradoxes and limitations are well illuminated as are the findings of The Committee for the Study of Sex Variants (in the 1930s) and Mercer's massive survey of topics ('They Walk in Shadows') that reiterated many of the established arguments for the acceptance of homosexuality.

The publication of the roundly criticized (for methodology) volumes on sexuality by Kinsey marked the initial shift of homosexuality from pathology to the subscription of variation. Ford and Beach showed that homosexuality was common across cultures and in non-human primates: it was natural and widespread. Hooker compared the projective test results from an equal number of gay and straight men to show that experienced judges could not distinguish between the two groups: it germinated that homosexuality was perhaps not associated with mental illness. Future views of homosexuality as an illness could only be based on a defective assumption of pathology. By the 1970s psychiatrists like Marmor, a psychoanalyst and president of the American Psychiatric Association, published works to reject the notion of homosexuality as pathology. Homosexuality was classified as a sexual deviation in the first edition (1952) of Diagnostic and Statistical Manual of Mental Disorders (DSM), where it was designated a sociopathic personality disorder. The declassification of homosexuality per se as a type of mental illness in 1973 and the elimination of any reference to it from the revised third edition of DSM in 1986 represent the final acknowledgment by the psychiatric profession that homosexuality by itself is not a mental illness, thus officiating the acceptance of new research findings. Biological studies claim public attention by continuing to focus on the determination of a single basis for homosexuality. Genetic linkage studies attempt to locate a "gay gene". There being no evidence for endocrine differences between homosexual and heterosexual persons, studies now refocus upon prenatal hormonal influences. The results of studying organic brain function and structure have not been replicated. Each fascinating category of approach is afforded a fair table of discussion in Terry's book.

Loss of lesbian parental custody, the passage of the DOMA (Defense of Marriage Act) and the proscriptive "Don't Ask, Don't Tell" Military Policy are gingered over the sidelines of the book's challenging canvas. While the medical concerns of homosexual persons will be the same as those of the general population, the former are at demonstrably higher risk for suicidality, domestic violence, hate-based crimes, alcohol and substance abuse, and issues with sexuality and sexual dysfunction. Many health care providers continue to believe that homosexuality is associated with mental dysfunction, report discomfort with homosexual patients, admit to bias and may even attempt to change a person's sexual orientation when it is not heterosexual! The effects of the physician's sexual orientation and of disclosure to the patient are infinitely more complex. These labyrinthine issues have been overlooked in an otherwise comprehensive text. Terry correctly states that neither the public's awareness nor the growing visibility of homosexuality will necessarily lead to increasing tolerance by society as a whole. As Kinsey stated in 1948: "Rarely has man been more cruel against man than in the condemnation and punishment of those accused of the so-called sexual perversion. Such cruelties have not often been matched, except in religious and racial persecutions." Terry sandboxes elementary subject material in a raw clinical perspective that makes for some difficult reading.

Dr. Nayak is an Assistant Professor of Clinical Radiology in the University of California School of Medicine San Francisco and his interests include mental health, medical ethics, and gender studies. A voracious reader and intrepid epicure, he enjoys his keyboards too much. He wonders why homosexuality is such a big deal: such a source of public controversy and such a cause of private pain.

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